Q & A + A Panel Discussion

Q and A for Megan

Has epistim been shown to improve hand function?

Yes! Look at Chet Moritz’s work.

Congratulations for doing that replication study! You validated the work of the Louisville team, which was a giant step forward. (He’s taking a very long time to ask the following:) Why don’t we work on crawling? Humans start with crawling … crawling is easier.

Good question. I’ve been thinking a lot about what we’ve learned from the stroke population over the last few decades about neuroplasticity and the reflexive nature of motor functions. We haven’t done it yet, but we will.

Do your patients have tone and spasticity?

Yes, both of them.

Annnnd that’s all the time for questions to Megan, but it’s okay because she’s going to be on a panel with the other morning presenters, moderated by our old friend Lyn Jakeman, who’s here from the NIH.

At the dais we have: Lyn Jakeman, David Magnuson, Megan Gill,  Andrei Krassioukov

Lyn starts by talking about the critical importance of what Dr Krassioukov talked about: autonomic functions. No rehab. On the other hand, Dr. Magnuson talked about LOTS of rehab. Megan talked about validation of other studies and deviating from them. What we’d all like to know is, how much validation of epistim efficacy is enough and how specific does it have to be?

Megan: What is it we’re trying to validate? We have close to 100% success rate with motor volitional activation. (“motor volitional activation” means being able to move something below the injury on command.)

Lyn: How important is it to understand exactly HOW something is working as part of the validation process?

David: Very important. The validation has to involve learning how so that we can apply what we’re learning in the broadest possible way. There’s also validating the concept … we validated the concept that rats are re-training themselves without replicating the experiment. We’re trying to show that something is applicable.

Lyn: Andrei, challenge your panelists here …how much validation is needed? Should we be doing these things in parallel?

Andrei: As a doctor, I want first to be sure that what we’re doing is safe. Then I want to give my patients something that helps as a whole. I would always ask questions like, can we study simultaneously what happens to the autonomic functions at the same time we’re looking at something like hand function?

Lyn: People will say that the NIH makes us stick to one outcome measure. But we don’t have any say in what gets developed. We have to speak to what ALL of the risks and ALL of the benefits are. So the way studies get designed requires that studies not be subject to misinterpretation. We have to press for what can be demonstrated statistically. We the NIH don’t prevent the collection of multiple outcome data … we just have to be able to show that the intervention is what caused the results claimed.

David: (To Andrei) Do we need separate modulation strategies, or can there be synergies?

Andrei: We have separate systems for motor, heart, and so on …. we have to address them in that way with stimulation.

David: I’d argue against that … there is integration through function. Hindlimb activity encourages blood flow through the heart. So motor activity does have an impact on the heart, yes? Can’t we put some things together?

Andrei: Yes, but we’ll still need to address the ways in which these are separate …

Lyn: (Addressing us at our tables, because it’s time for discussions amongst ourselves): Think about risk, cost, fairness, and how we collaborate with each other to figure out the answers to these questions.

Matt: Those questions apply to all of you in this room, not just the people in chairs. People in industry, science, everyone has to consider how this particular therapy can make its way into the system.

There’s a facilitator at each table … go.

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